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by GK Strategy 11th April, 2017

Prevention and R&D are the key to cracking antimicrobial resistance: public policy needs to go further

Antimicrobial resistance (AMR) – the ability of bacteria and viruses to develop immunity to antibiotics and other antimicrobials – continues to be a crucial issue on the health policy agenda. The Chief Medical Officer, Dame Sally Davies, declared it to be “a catastrophic threat” which, if not addressed, could mean “any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics”. In his key report on the issue as a Treasury Minister, Lord O’Neill of Gatley reported that the current cost of AMR to the NHS is estimated to be in excess of £180 million per annum, resulting in 3,000 deaths a year in the UK alone. He warned that, without global action, AMR will kill another 10 million people annually by 2050. This also poses an economic threat: the increased number deaths and illness would in turn wipe approximately $8 trillion (€7 trillion) of the world’s annual output by 2050.

As a result of these stern warnings, public policy has steadily begun to respond. David Cameron raised the threat from growing resistance to antibiotics with world leaders at the G7, and announced a new £50 million Global Antimicrobial Resistance Innovation Fund (GAMRIF) with the aim of attracting significant additional investment internationally to stimulate global research into solutions. Such solutions mainly fall under 3 main themes: antimicrobial stewardship, infection prevention, and R&D.

Antimicrobial stewardship is the practice of restricting unnecessary use of antibiotics which encourages viruses and bacteria to develop resistance. Indeed, this was a key focus of Lord O’Neill’s report, which considered the supply and demand of antibiotics, which is not surprising given his background as an economist. Special financial incentives are being offered to encourage hospitals to reduce prescriptions. The Department of Health is currently working with NICE and the Association of the British Pharmaceutical Industry (ABPI) to develop a new reimbursement model for antimicrobials, which would delink revenues from sales, reducing the commercial inventive of over prescription.

The area where such stewardship is most needed is agriculture, with 80% of all antibiotics used in the US and 45% in the UK given to farm animals. The private sector is slowly starting to respond, with KFC announcing this week that its chicken will go antibiotic free from the end of 2018. However, restricting unnecessary supply is not enough, there will always be a need for a supply of new antibiotics to combat the bacteria which is fast developing resistance.

Improving infection prevention stops people from needing antibiotics in the first place, and so should be the first step in the fight against AMR. Hospitals such as Burton are leading the way with innovative practice to increase hand hygiene to prevent the spread of infection, but such practice is not yet widespread enough. Not only does improving hospital hygiene reduce the human and economic cost of AMR, but reducing rates of healthcare associated infections (HCAIs) would relieve demand for beds on an under-pressure NHS.

The main way to get ahead of AMR is to stay ahead of the curve on innovation. Just as bacteria adapt to develop immunity to traditional antibiotics, so should our antibiotics adapt to defeat the bacteria. The O’Neill report recommended the Government should provide “better incentives to promote investment for new drugs and improving existing ones”, while a recent PwC report also recommended that the Government should “increase R&D funding”. Such funding should cover direct investment in research, as well as incentives for companies, from small biotechs to big pharma, to successfully develop new products. This is no small commitment: mainstream estimations of the scale of public sector rewards needed to incentives new antibiotics include figures from $919 million to $2.5 billion. Innovation mainly comes from small enterprises, yet these struggle to maintain finance during the long research process (for instance paying researchers and funding clinical trials), to the long regulatory process. Developing new antibiotics can take time: it took nearly 12 years to develop penicillin, but if this is not accelerated we will fall behind in the struggle against AMR.  The rewards for businesses and investors need to match the size of the challenge.

Given the importance of R&D, it’s disappointing that the Government recently stated that the GAMRIF “is not looking at reimbursement models to incentivise the development of new classes of antibiotics or planning to fund pilots at this stage.” The economics suggest that this is precisely what government should be doing. However, although such indirect funding has a long way to go, the GAMRIF will look to directly support research and development of new products. While David Cameron and George Osborne made addressing AMR a priority, their successors are yet to acknowledge the severity of the threat. Theresa May and Phillip Hammond need to show they take the issue as seriously and that they are as committed to investing now to stop the costs of AMR later. AMR will not wait for the Brexit negotiations to be concluded, so neither should public policy.

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